| NPI | 1992971519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MD D69502) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX N2742) |
| Enumeration Date | 2008-05-03 |
| Last Update Date | 2013-07-31 |